Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 991: Which of the following statements related to gastric injury is NOT true?

A. Heals well and fast
B. Mostly related to penetrating trauma
C. Blood in stomach is always related to gastric injury (Correct Answer)
D. Treatment is simple debridement and suturing

Explanation: **This question asks for the statement that is NOT true (i.e., the FALSE statement) about gastric injury.** ***Blood in stomach is always related to gastric injury*** - This is the **FALSE statement** and therefore the correct answer to this "NOT true" question. - The presence of **blood in the stomach can be due to various causes** beyond direct gastric injury, including **peptic ulcers, gastritis, esophageal varices, or swallowed blood** from an upper airway bleed (epistaxis). - This statement makes an absolute claim ("always") that is medically incorrect, as numerous other conditions can lead to **gastrointestinal bleeding** manifesting as blood in the stomach. *Heals well and fast* - This statement is **TRUE** and therefore not the answer. - **Gastric injuries generally heal relatively well and quickly** due to the **rich blood supply** (from celiac axis branches) and excellent regenerative capacity of the gastric mucosa. - The stomach has one of the best healing rates among hollow viscus injuries in abdominal trauma. *Mostly related to penetrating trauma* - This statement is **TRUE** and therefore not the answer. - Most traumatic gastric injuries result from **penetrating trauma** (stab wounds, gunshot wounds) rather than blunt trauma. - The stomach's mobility and protected position behind the rib cage makes blunt gastric injury relatively uncommon; when it occurs, it's usually with severe mechanism or full stomach. *Treatment is simple debridement and suturing* - This statement is **TRUE** and therefore not the answer. - For most gastric injuries, particularly **lacerations and small perforations**, treatment involves **debridement of devitalized tissue and primary closure** (simple suturing in one or two layers). - The excellent blood supply and healing capacity of the stomach makes simple repair highly successful in most cases. - Complex injuries with significant tissue loss may require more extensive procedures like partial gastrectomy or Graham patch repair, but these are less common.

Question 992: A 45-year-old with trauma presents after 4 hours with cheek swelling and has not passed urine. On examination, crepitus is palpated with periorbital swelling. What is your diagnosis?

A. Lung laceration
B. Base of skull fracture (Correct Answer)
C. Renal shut down
D. Gas gangrene

Explanation: ***Base of skull fracture (Best answer among given options)*** - **Crepitus** (subcutaneous emphysema) with **cheek swelling** and **periorbital swelling** after facial trauma classically indicates **fracture of air-containing structures** in the facial skeleton, most commonly **paranasal sinuses** (frontal, ethmoid, or maxillary). - While this presentation more specifically suggests **maxillofacial fracture involving sinuses**, among the given options, **base of skull fracture** is the closest diagnosis as it can be associated with complex facial trauma. - The **crepitus** occurs when air from fractured sinuses dissects into surrounding soft tissues, creating the characteristic crackling sensation on palpation. - The **inability to pass urine** may suggest concurrent injuries or neurogenic bladder dysfunction from associated trauma, though this is not the defining feature of the diagnosis. *Lung laceration* - Lung laceration presents with **respiratory distress, chest pain, hemoptysis**, and signs of **pneumothorax or hemothorax** on chest examination. - While lung injury can cause **subcutaneous emphysema**, it typically tracks along the chest wall and neck, not selectively to the **cheek and periorbital region** following facial trauma. - The clinical presentation here is localized to the **facial region**, making intrathoracic injury unlikely as the primary diagnosis. *Renal shut down* - **Acute renal failure** presents with **oliguria/anuria** along with systemic signs like fluid overload, electrolyte disturbances, and rising creatinine. - **4 hours without urination** is insufficient to diagnose renal shutdown; this could represent pre-renal azotemia from hypovolemia, urinary retention, or simply inadequate time for assessment. - This diagnosis does **not explain** the focal findings of **crepitus, cheek swelling, and periorbital swelling**, which are the key clinical signs pointing to facial skeletal injury. *Gas gangrene* - **Gas gangrene** is a life-threatening **clostridial infection** presenting with severe pain, skin discoloration (bronze/purple), bullae, foul-smelling discharge, and systemic toxicity. - It develops **12-24 hours or more** after contaminated wounds with devitalized tissue and anaerobic conditions, not within **4 hours** of trauma. - While it produces **crepitus from gas production**, the clinical context, timing, and absence of infection signs make this diagnosis incompatible with the acute traumatic presentation described.

Question 993: How much daily sodium does an average patient with maxillofacial trauma require?

A. 1000 mmol
B. 50-60 mmol
C. 10 mmol
D. 100 mmol (Correct Answer)

Explanation: ***100 mmol*** - An average adult patient with **maxillofacial trauma** typically requires around **100 mmol** of sodium daily for maintenance. - This amount helps maintain **fluid balance**, nerve impulse transmission, and muscle function without causing hypernatremia or hyponatremia. *1000 mmol* - This quantity of sodium is excessively high and could lead to **hypernatremia**, **fluid overload**, and significant **electrolyte imbalances**, which are dangerous for most patients. - Such high doses are generally only seen in cases of severe sodium depletion or massive fluid resuscitation, neither of which is implied for routine daily needs after trauma. *50-60 mmol* - This amount of sodium is generally **insufficient** for the daily maintenance needs of an average adult, especially in the context of trauma where needs might be slightly elevated due to stress response. - Inadequate sodium intake could lead to **hyponatremia** over time, causing symptoms like nausea, headaches, and confusion. *10 mmol* - This is an extremely low amount of sodium and would almost certainly lead to **severe hyponatremia** in an average adult within a short period. - Such a low intake would not meet basic physiological requirements and could rapidly result in life-threatening complications.

Question 994: All are true about Flail chest, except:

A. If overlapping of fractured ribs with severe displacement is seen then patients are treated surgically with open reduction and fixation
B. Paradoxical movement is never seen in flail chest (Correct Answer)
C. PaO2 < 60 treated with intubation and PEEP
D. Fracture of at least 3 ribs

Explanation: ***Paradoxical movement is never seen in flail chest*** - A definitive characteristic of a **flail chest** is the **paradoxical movement** of the chest wall segment. - This occurs because the **detached segment** moves inward during inspiration and outward during expiration, opposite to the rest of the chest. *If overlapping of fractured ribs with severe displacement is seen then patients are treated surgically with open reduction and fixation* - **Surgical fixation** is indicated for **severely displaced** or overlapping rib fractures in flail chest to stabilize the chest wall and improve respiratory mechanics. - This intervention aims to reduce pain, shorten ventilator time, and prevent long-term pulmonary complications. *Pa02 < 60 treated with intubation and PEEP* - **Hypoxemia** with a **PaO2 persistently below 60 mmHg** in a flail chest patient despite supplemental oxygen is a strong indication for **endotracheal intubation** and **positive end-expiratory pressure (PEEP)**. - PEEP helps to re-expand collapsed alveoli, improve oxygenation, and stabilize the flail segment internally. *Fracture of atleast 3 ribs* - A flail chest is defined as a fracture of **three or more adjacent ribs** in **two or more places**, creating a segment of the chest wall that is no longer continuous with the rest of the thoracic cage. - This discontinuity is what causes the characteristic paradoxical motion and compromises ventilatory mechanics.

Question 995: A patient met with an accident and presents with paralysis of both upper and lower limbs. The patient has not passed urine and tenderness is elicited in the cervical region. What is the most appropriate immediate management?

A. The doctor will instruct the radiographer to take cervical and chest x-ray
B. The doctor should order a cervical x-ray and shift the patient from the trolley by himself
C. The patient should not be shifted and portable x-ray machine should be used after neck stabilization (Correct Answer)
D. The doctor will instruct the radiographer to take cervical x-ray AP and lateral view without any cervical support

Explanation: ***The patient should not be shifted and portable x-ray machine should be used after neck stabilization*** - This approach minimizes movement of a potentially unstable cervical spine fracture, preventing further neurological damage and optimizing patient safety. - **Spinal immobilization** (e.g., with a cervical collar and backboard) is the first priority before any diagnostic imaging to protect the spinal cord. - Using a **portable X-ray** avoids the need to transport the patient to radiology, adhering to trauma management principles. *The doctor will instruct the radiographer to take cervical and chest x-ray* - While cervical and chest X-rays are appropriate investigations, this option lacks the critical detail of **neck stabilization** and the need for a **portable X-ray** to avoid patient movement. - Moving the patient to a radiology suite for standard X-rays can exacerbate a spinal injury, especially without proper immobilization. *The doctor should order a cervical x-ray and shift the patient from the trolley by himself* - Shifting the patient from the trolley without adequate assistance and proper technique carries a high risk of causing further **spinal cord damage** due to uncontrolled movement. - This approach directly violates principles of **spinal precautions** in trauma management and requires at least 4-5 trained personnel for safe log-rolling. *The doctor will instruct the radiographer to take cervical x-ray AP and lateral view without any cervical support* - Taking X-rays without **cervical support** or immobilization is extremely dangerous in a patient with suspected cervical spine injury and paralysis. - Lack of support during imaging can lead to increased spinal instability and potentially irreversible **neurological deficits** or even death.

Question 996: Steering wheel injury on chest of a young man reveals multiple fractures of ribs and paradoxical movement with severe respiratory distress. X-ray shows pulmonary contusion on right side without pneumothorax. What is the initial treatment of choice?

A. Immediate internal fixation
B. Thoracic epidural analgesia and O2 therapy
C. Endotracheal intubation and mechanical ventilation (Correct Answer)
D. Stabilization with towel clips

Explanation: ***Endotracheal intubation and mechanical ventilation*** - The presence of **paradoxical chest wall movement** (flail chest) with **severe respiratory distress** indicates compromised ventilation and impending respiratory failure. - **Mechanical ventilation** provides **internal pneumatic stabilization** of the chest wall, restores adequate oxygenation, and supports breathing in patients with severe flail chest and pulmonary contusion. - In the setting of **severe respiratory distress**, immediate airway control and ventilatory support take priority. *Thoracic epidural analgesia and O2 therapy* - **Epidural analgesia** with oxygen therapy is an effective strategy for flail chest management and may be adequate for patients **without severe respiratory distress**. - However, in the presence of **severe respiratory distress** as described in this scenario, more definitive airway management is required first. - This approach alone is insufficient when ventilatory failure is imminent or present. *Immediate internal fixation* - While surgical rib fixation can be considered for severe flail chest, it is typically a **delayed intervention** performed after initial stabilization and resuscitation. - **Immediate surgery** for rib fixation is not the priority in an acutely distressed patient requiring urgent airway management. *Stabilization with towel clips* - **External stabilization** methods like towel clips or weighted sandbags were historically used but are **no longer recommended** due to poor effectiveness and potential complications. - These methods do not address the underlying ventilatory failure and can impede respiratory mechanics further.

Question 997: A patient who met with an accident presented to the emergency department, he lost 25% of his total blood volume approximately, blood pressure is normal. He/she will be classified under which class of hypovolemic shock?

A. Class II (Correct Answer)
B. Class I
C. Class III
D. Class IV

Explanation: ***Class II*** - A 25% blood loss (within the **15-30% range**), with **blood pressure remaining normal**, categorizes this patient into **Class II hypovolemic shock**. - In Class II, compensatory mechanisms such as increased **heart rate** and **peripheral vasoconstriction** maintain systolic blood pressure despite significant volume loss. - Patients typically present with **tachycardia (100-120 bpm)**, **narrowed pulse pressure**, mild **anxiety**, and **normal systolic BP**. *Class I* - Class I shock involves **minimal blood loss** (up to 15%), with blood loss <750 mL in adults. - Patients in Class I typically present with **normal vital signs** and minimal to no clinical symptoms. - The 25% blood loss exceeds the threshold for Class I classification. *Class III* - Class III shock is characterized by blood loss of **30-40%** (1500-2000 mL in adults). - This level of loss typically results in **decreased systolic blood pressure**, **marked tachycardia (120-140 bpm)**, **confusion**, and clinical instability. - The patient's normal blood pressure and 25% loss are **below the threshold** for Class III shock. *Class IV* - Class IV shock involves massive blood loss of **greater than 40%** (>2000 mL in adults). - Presents with profound **hypotension**, **severe tachycardia (>140 bpm)**, **altered consciousness**, and **imminent cardiovascular collapse**. - This patient's normal blood pressure and stable condition are inconsistent with Class IV shock.

Question 998: Which of the following is the most common cause of hypotension in fractures of the lower ribs (ribs 10-12)?

A. Injury to aorta
B. Intercostal artery damage
C. Pulmonary contusion
D. Abdominal solid visceral organ injury (Correct Answer)

Explanation: ***Abdominal solid visceral organ injury*** - Fractures of the **lower ribs (T10-T12)** are highly suggestive of associated injury to **intra-abdominal solid organs**, such as the **spleen, liver, or kidneys**. - These organs are highly vascular, and trauma can lead to significant **hemorrhage** into the abdominal cavity, causing **hypotension** and hypovolemic shock. *Injury to aorta* - While an aortic injury is life-threatening and causes severe hypotension, it is less commonly associated with **isolated lower rib fractures (T10-T12)**. - Aortic injuries are more often linked to severe blunt trauma with **deceleration forces** or fractures of the **upper ribs** and sternum. *Intercostal artery damage* - Damage to intercostal arteries can cause bleeding and contribute to hematomas, but the volume of blood loss is usually **insufficient** to cause severe systemic **hypotension** alone. - Intercostal artery hemorrhage is typically localized and does not quickly lead to hypovolemic shock unless multiple vessels are involved or combined with other injuries. *Pulmonary contusion* - A pulmonary contusion is bruising of the lung tissue that can impair gas exchange and potentially lead to **respiratory distress** and hypoxemia. - While it can be serious, a pulmonary contusion generally does not directly cause significant **blood loss** or severe **hypotension** as its primary effect.

Question 999: In splenic injury, conservative management is done in which of the following?

A. Extreme pallor and hypotension
B. Young patient (Correct Answer)
C. Shattered spleen
D. Hemodynamically unstable

Explanation: ***Young patient*** - **Conservative management** of splenic injury is often favored in **younger patients** due to their greater capacity for healing and the desire to preserve splenic function. - The risk of **overwhelming post-splenectomy infection (OPSI)** is higher in children, making splenic preservation a priority. *Extreme pallor and hypotension* - **Extreme pallor** and **hypotension** are signs of significant blood loss and **hemodynamic instability**, which typically necessitate surgical intervention. - **Conservative management** is usually contraindicated in such cases as the patient is actively bleeding. *Shattered spleen* - A **shattered spleen** indicates a severe, often **grade IV or V** splenic injury, where the spleen is extensively fragmented. - This level of injury is associated with uncontrollable bleeding and almost always requires **splenectomy**. *Hemodynamically unstable* - **Hemodynamic instability**, characterized by persistent hypotension, tachycardia, or inadequate organ perfusion, is a **contraindication** to conservative management. - Patients who are **hemodynamically unstable** need immediate surgical exploration to control bleeding.

Question 1000: Wallace rule is better known as?

A. Rule of 10% in pheochromocytoma
B. Rule of 90% in pheochromocytoma
C. Rule of 9 in burn assessment (Correct Answer)
D. None of the options

Explanation: ***Rule of 9 in burn assessment*** - The **Wallace rule**, also known as the **Rule of Nines**, is a standardized clinical tool used to estimate the total body surface area (TBSA) affected by burns in adults. - It divides the body into sections that are roughly 9% or multiples of 9% of the total body surface area to guide fluid resuscitation. *Rule of 10% in pheochromocytoma* - The **Rule of 10%** in pheochromocytoma describes that approximately **10% of pheochromocytomas** are extra-adrenal, bilateral, malignant, or familial. - This rule is not referred to as the Wallace rule. *Rule of 90% in pheochromocytoma* - This term is **not a recognized medical rule** or mnemonic. - It does not correspond to any established clinical guidelines for pheochromocytoma. *None of the options* - This option is incorrect because the **Rule of 9 in burn assessment** is the correct alternative name for the Wallace rule.

Practice by Chapter

Initial Assessment of Trauma Patient

Practice Questions

Advanced Trauma Life Support (ATLS) Principles

Practice Questions

Chest Trauma

Practice Questions

Abdominal Trauma

Practice Questions

Head Trauma

Practice Questions

Spinal Trauma

Practice Questions

Extremity Trauma

Practice Questions

Vascular Trauma

Practice Questions

Genitourinary Trauma

Practice Questions

Burns Management

Practice Questions

Mass Casualty Management

Practice Questions

Damage Control Surgery

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?